A novel maneuver to facilitate retrograde wire externalization during retrograde chronic total occlusion percutaneous coronary intervention

Background: Although the retrograde approach has improved the success rate and procedural efficiency of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), it can still be challenging and time-consuming. We introduce a novel technique that aims to facilitate the critical step of retrograde wire externalization during reverse controlled antegrade and retrograde tracking and dissection (CART), which we named DRAFT (Deflate, Retract and Advance into the Fenestration Technique). Materials and Methods: DRAFT is performed by simultaneous retraction of the deflating antegrade balloon (after inflation in the subintimal space) and advancement of the retrograde looped wire in the same plane through the transient fenestrations created by reverse CART, in order to cross through the fenestrated dissection flap before its collapse. The retrograde wire is then quickly and easily advanced into the antegrade guiding catheter. Results: DRAFT was used in 11 patients (8 with right coronary artery and 3 with left anterior descending artery CTOs). Several different guidewires were used, since this technique does not need any specific wire to be performed. DRAFT was successful in all cases, after at most five attempts. CTO PCI was then completed as per standard retrograde practice. No complications occurred. Conclusions: DRAFT is a versatile approach that allows easy and quick re-entry of the retrograde wire into the true lumen during reverse CART. It can be performed with a variety of guidewires and is feasible both in the left and right coronary arteries. © 2016 Wiley Periodicals, Inc.